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Children with flat feet, also called pes planus, have a flattening of the arch during standing and walking.

Flat foot is normal in infants and young children. At this age, in the absence of any associated symptoms, treatment is highly debatable.

Flat foot usually naturally corrects itself as muscles strengthen and soft tissues stiffen. The height of the arch in the foot increases with age until about 9 years. The problem is when flat foot persists, spontaneously occurs in older children or later in life, or is associated with pain and disability.

Flat feet can be flexible or rigid, painful or painless and associated with a tightness of the calf muscles (Achilles tendon). The majority of flat feet are painless, but when pain is present it is usually during weight-bearing activities such as walking and running. The pain can be in the sole of the foot, the ankle, or non-specific pain all around the foot area.

What causes flat feet?

A complex and sophisticated interaction of bones, ligaments, muscles and nerves within and above the foot defines its anatomy and function. Anything that interrupts the integrity of these structures leading to a collapsed arch can cause symptomatic flat feet.

Examination of the foot begins with an examination of the entire child, because the flat foot may have an underlying cause.

Flat foot can also originate from unusual anatomy such as a tarsal coalition (bones joined together), ligament or muscle damage, restricted ankle movement, outward rotated lower legs, and knock knees (where the legs bow inwards at the knee). Obesity can result in collapse of the arches by the increased load on the foot. If knock knees also develop, the middle of the foot will tend to turn out (abduct). The foot will point outwards when walking, instead of straight ahead, which is inefficient and can cause early fatigue.

Footwear in early childhood has been thought to cause flat foot. It is likely that children who wear shoes, are not physically active and have flat feet will have decreased muscle activation in their feet and thus impaired foot function and weakness.

Some older children and adolescents develop flat feet in the absence of any disorder or associated factors.

Does flat foot need to be treated?

Flat feet require treatment only if clearly associated with pain or decreased function. Managing the underlying cause or disease is of highest priority; just treating the symptoms should be secondary.

If flat foot is observed in a child who is overweight and has knock knees, or in a child with excess joint flexibility and poor footwear, each of these factors could be contributing to the symptoms, and each should be addressed.

If a child’s quality of life is affected by how their feet look, feel or function, then the associated issues should be addressed.

There are many causes of leg pain right from muscle cramps and inflammation of tendons to arthritis, varicose veins and nerve damage. Leg pain due to muscle strain following an injury or wearing tight shoes for a long time can be prevented by following few simple tips:

Stretch the leg muscle: One of the most effective ways to prevent leg pain due to a sudden muscle twist or cramp is to stretch the muscle. This not only improves blood flow to the injured muscle but it also helps in reducing muscle tension thereby relieving muscle soreness.

Take a warm shower: If you suffer from leg pain, then take a warm shower to relax the muscles. If taking a bath is not feasible, then placing a heating pad on the affected areas can also help. A heat pack works best if the pain is due to a previous injury as it not only relaxes blood vessels but also improves blood circulation, alleviating leg pain.

Wear a proper fitting athletic shoe: Most people fail to choose the right fitting shoe, which is one of the common causes of leg and heel pain. To get the right fit, determine the shape of your foot using the ‘wet test’. For this, step out of the shower onto a surface that will show your footprint, like a brown paper bag. If you have a flat foot, you will see an impression of your whole foot on the paper. If you have a high arch, you will only see the ball and heel of your foot. When shopping, look for athletic shoes that match your particular foot pattern.

Choose the right sports shoe: Not many people are aware that different types of shoes are specially designed to meet your sports requirement. Did you know running long distances in court-style sneakers can contribute to shin splints? It is important to choose the shoes according to your sport or fitness routine.

Go slow if you are a beginner at the gym: One of the common mistakes that most people commit is to overexert on the first day of the gym, which not only exerts pressure on the knee but also causes muscle soreness and leg pain. The key to preventing leg pain and sticking to your workout routine is to build your fitness level slowly. You can start off with less strenuous workouts and then gradually increase the duration, intensity, and frequency of your exercise regimen.

To avoid in-store arguments, parents and children should discuss in advance the style and brand of shoes they want to look for.

Remember that a good fit is more important than the size of the footwear. A good fit allows for a 1/2” of space between the end of the toes and the end of shoe. Shop at retailers who provide a fit specialist for extra assistance.

Remember that not all shoes of the same size fit alike. While foot measurement is a starting point, how the shoes fit is more important.

Match the shape of the shoe to the shape of the foot.

Remember that while a low arch is normal in young children, in children older than age seven, the lower the arch the more important it is to have shoes with good support. Look for a firm heel counter and stiffness when trying to twist shoes lengthwise.

If a child wears orthotics, select shoes with removable foot beds and try the shoes on with the orthotics in place.

Remember that price is not necessarily commensurate with quality. If price is a consideration, last year’s models can offer all the features needed at a discounted price.

Check the fit on your child’s shoes on a regular basis as children’s feet grow at irregular rates.

For more information, or if you have any questions, contact The Podiatrist

The importance of our feet has been understood for centuries. Even the Greek philosopher Socrates is reputed to have said, “To him whose feet hurt, everything hurts.” So, what comprises foot care that promotes comfort at any age?

Wear shoes and socks that fit and are comfortable.

Be sure your toes are not cramped.

Change socks daily and if possible have two pairs of shoes in everyday use so that you can alternate the pairs daily.

Elastic laces are handy if your feet swell.

Shoes should be worn that cover, protect, provide stability for the foot and minimize the chance of falls.

Whatever your age – student or grandparent – foot care is important.

Remember to cut or file your nails straight across and never shorter than the end of your toe.

If you are older, and particularly if you are diabetic, it is helpful to get The Podiatrist to do your foot care.

It is best to wash feet daily and always test the water’s temperature beforehand. Pat, do not rub, your feet dry and remember to dry between and under the toes. If your feet are bothering you you’ll find that short soaks of even ten minutes are soothing.

Use a lanolin (ointment base) moisturizing cream for dry and cracked skin. If your feet perspire, dust lightly with talcum powder. Remember to remove excess cream of powder from between your toes to avoid skin problems. If you are diabetic it is wise to examine your feet daily.

Exercise each day if possible. Walking is always good but there are also special foot exercises that can be done like rolling your feet over a rolling pin several times daily or picking up a crumpled towel with your toes.

Despite reasonable care throughout life, however, the older foot is subject to problems. Heredity is a factor as are the stresses over the years and complications from systemic diseases. It has been estimated that at least 80 percent of people over 50 have at least one foot problem.

The most common are corns and calluses, ingrown toenails, bunions, hammertoes, strained arches, heel pain and arthritis including gout.

In many cases there can be improvements jus by switching shoes to the type with wider, box-type toes. Also. shoe size can actually change with added years.

Feet carry our body’s weight, help hold us erect, co-ordinate and maintain balance in walking. We need to give them tender, loving and skilled care.

Issues with feet can affect anyone at any age. Parents shouldn’t assume that signs of foot problems in children are merely “growing pains.

Managing children’s health is complicated enough, especially for first-time parents. It can be a struggle to truly know and even understand which signs and symptoms are temporary and which point to more serious concerns.

In truth, the professionals a The Podiatrist and Kidsnmotion agree that there are some pediatric foot problems that resolve themselves with growth and time. However, there are clear signs when children need medical help.

Common foot problems can range from pediatric flat foot, toe walking, in-toeing and flat or high arches to tarsal coalitions (an abnormal bridge of tissue that connects two normally separate tarsal bones plus extra bone growth — quite simply, when the bones of the feet fail to separate during fetal development).

While these conditions of the feet and their treatments are different, they share some common signs that show parents there is a problem that needs to be addressed:

Pain, swelling and redness that does not subside

Development of thick calluses in one area of the foot

Problems with the way your child walks

Shins or thighbones that appear to turn inward

Ankles that are weak or easily give out

As much as your child’s general health and well-being is important, do not ignore symptoms; foot health is just as important as any other medical examination.

There are several treatment options for these conditions. Whether a less invasive approach — such as shoe modifications, orthotic devices and physical therapy — or a more intensive intervention — such as bracing, steroid injections or even surgery — is needed, The Podiatrist can advise parents on which treatment offers the best long-term prognosis.

If you believe that a family member is experiencing any of the above symptoms, perhaps it’s time to seek professional help and book a consultation for a thorough examination, diagnosis and possible treatment with The Podiatrist.

Our core is much more than just our abdominals. It includes the thoracic and lumbar spine, abdominal muscles, back muscles, pelvic and hip girdle muscles (especially the gluteals) and the thigh muscles.

Core exercises should be a key component of any training program – especially a distance running program. A correctly functioning core will yield proper biomechanics and force production, providing stability (including lumbar, pelvic, and lower limb stability), power and endurance.

When your core is weak, it can lead to increased strain in other parts of your body and could contribute to compensation and overuse movement patterns, over-striding or under-striding with running and increased frontal plane movements (side to side movements) of the lumbar spine, pelvis and hips.

These compensatory movement patterns will lead to overuse injuries and have been linked to various disorders common to runners, including:

Iliotibial band (IT Band) syndrome — The iliotibial band is a thick band of fascia (a thin sheath of fibrous tissue enclosing a muscle or other organ) that crosses the hip joint and extends distally to insert on the patella, tibia, and biceps femoris tendon. Repetitive movements and overuse can cause irritation and inflammation in the knee or lead to snapping hip or hip bursitis.

Patellofemoral pain and dysfunction — The patella, your knee cap, floats within the trochlear groove on top of the femur. If the mechanics of your running is not ideal, then the kneecap may be pushed to one side of the groove when the knee is bent causing pain.

Low back and Sacroiliac (SI joint) disorders — SI joint is responsible for transferring the weight of the upper body to the lower body. It is located in the pelvis connecting the iliac bone (pelvis) to the sacrum (the lowest part of the spine). With a lot of repetitive movements you can cause hypermobility of the joint.

Medial Tibial Stress Syndrome (shin splints) — This refers to the pain in the front of leg that develops when you increase your mileage too fast. Most of the time this is caused by a training error due to fatigue.

Achilles tendinopathy — The Achilles tendon connects the calf muscle to the heel bone. Tendinitis (inflammation) and Tendinosis (microtears in the tissue around the tendon) are common problems.

Plantar fasciitis – This band of tissue runs across the bottom of your foot and connects your heel bone to your toes. It is one of the most common causes of heel pain.

A core strengthening program can help prevent these types of injuries and should progress initially from “open-chain” (i.e. non-weight bearing) exercises toward “closed-chain” (weight bearing) exercises. The goal is to stimulate and train the muscles to function in a manner and position that they would normally when under stress.

In running, our bodies are erect, with weight bearing and landing on our legs, so the strengthening exercises should reproduce these positions and movement patterns. The exercises should also incorporate all planes of movement of the body to allow ideal muscle stimulation and development.

As you look at your children running around, it is the ideal time to focus on their foot health and well-being. Remember, it’s not normal to have pain in your feet, especially for a child.

One of the most common foot structures that can cause problems for children is flat foot, also known as pes planus. This is a condition in which there is abnormal collapse of the arch when standing. This causes excessive strain on the soft tissues and joints of the foot and ankle, which in turn, can cause pain and affect the way in which your child is able to function over time.

It is also common to have children complain of knee pain due to their abnormal foot structure, as you can imagine, if your foundation (your feet) is not functioning correctly then that affects the joints up the chain (your knees, hips, lower back).

Here are some early signs of flat feet:

1.Is your child 5 yrs or older? Any younger than this it is normal to have a flattened arch. It is around age 5 that you should start to see an arch form

2.When you look at the back of your child’s heels as they stand, do the heels tend to angle outward, with bowing of the Achilles tendon?

3.Does your child complain of foot, knee or ankle pain during or after activity? Or wake up in the middle of the night with these complaints?

4. Does your child tend to have early leg fatigue or seem to be clumsy with activity?

5. Do you, the parents, have flat feet? If so, there’s a good chance that your child will too since foot structure
is mostly hereditary.

Most parents want the best for their kids and will do what they can to ensure their child’s health and success. However, it’s not always on parent’s minds that if your child’s feet are functioning abnormally, their ability to perform in sports and play outside with their friends can be hindered, and even cause pain.

What should parents do if they suspect their child has flat feet?
It is recommended to have your child evaluated early, even before age 5 if the parents have flat feet. The earlier that your child’s feet are treated, the better the outcome is for improvement in their overall structure over time.

One of the most conservative and effective means of treatment for paediatric flatfoot is custom orthotic therapy. This is done by taking a mould of your child’s foot in what the corrected position should be and from this mould we can make an insert (orthotic) that will fit inside your child’s shoes to wear on a daily basis to keep their feet in the corrected position. The earlier we can start this correction, the greater the improvement in the structure of the feet we can make.

By doing this we can help keep your child active and happy. So remember, if you’re going shoe shopping – take a look at your child’s feet BEFORE you hit the stores. A visit to The Podiatrist may be in order. Some shoes are better than others for flat feet and knowing what to look for will save you time and money.

Sore feet are not only uncomfortable; they can put a big dent in your productivity and turn even the simplest task into a burdensome chore. Causes for sore feet can range from ill-fitting shoes to physical deformities, but luckily there are as many different solutions as there are problems; the trick is finding what works best for you. Many common foot problems like heel spurs, flat feet and torn ligaments can be solved best by using bio-mechanical intervention that can range from drug store variety inserts to custom-made orthotic devices.
Determining the Problem
To find the source of sore feet, start with the obvious culprit, ill-fitting shoes that do not provide the proper support for your body frame. So called “sensible shoes” with low profiles, sturdy arches and ankle support often provide instant relief from minor foot issues caused by inappropriate footwear. Under some conditions, like standing on hard or uneven surfaces all day, additional relief can be provided by drug store inserts that create a layer of cushioning for your feet to reduce the impact of each step. If these simple tactics do not yield favorable results, it is wise to consult with The Podiatrist to examine your feet to determine if you are suffering from treatable foot maladies that would benefit from custom-made orthotic devices.
Orthotic Solutions
The Podiatrist can examine your foot to determine if your problem results from an injury to or is the result of the way your foot functions in relation to the rest of your body. Injuries from sports and recreational activities can often be cured by providing proper support during the recuperation process so that the injury is not irritated and can heal properly. These types of inserts, pads and braces are temporary and will eventually become unnecessary.
If the problem lies in the basic structure of your foot, however, a more permanent orthotic will be recommended that is strategically designed to make your foot function correctly when you take a step. A cast of your foot is made and The Podiatrist uses this model to create the proper orthotic out of plastic, wood or rigid rubber. This kind of treatment can not only provide relief for sore feet, it can also have a direct impact on your legs and torso because it subtly changes your posture and corrects muscular issues that stemmed from improper balance.
See The Podiatrist for any foot problems.http://www.thepodiatrist.co.nz

Flat feet and turned feet are commonly seen in young children.
Flat feet happen when the arch of the foot is flatter than normal. It can be much flatter than normal. While flat feet are seen in people of all ages, it is most noticed at first in children. In many cases, the arch will form with age. However, for some children, the flattening causes painful feet.

Flat feet become more noticeable when the child starts to walk, and by the age of 3 the arch should be able to be seen during walking. If the feet are still flat at this age, then parents should have their child’s feet examined by The Podiatrist. If the arch is not looked at, then the child risks long term damage to the feet.
Turned feet can be noticed even before a child starts to walk.
Your child’s feet should not be turned in or out excessively. The foot should not be upward resting on or too near the leg. When holding your baby, the feet should hang naturally and similarly – one should not be turned out, in up or down more than the other. Many early foot deformities can occur only on one side.
Signs of a flat foot are a low or flat arch, an outward turned heel during walking.
The child may complain of sore or tired feet after walking or playing. Children with painful flat feet sometimes have trouble keeping up with friends because their feet get too sore or tired. If the arch is too flat, then foot muscles and joints have to work harder than normal during walking and running. Flat feet also change how the ankles, knees, legs, hips, and back work, and so there may also be pain and tiredness in these places.

Depending on the examination and history of the problem, The Podiatrist may decide to treat the flat feet. If the flat feet are mild, and if the child is still very young, The Podiatrist may simply want to see the child back in a few months. This way we can re-check the arches. If the flat feet are more severe, then treatment may be started. Usually treatment begins with exercise and foot inserts, or orthotics. The orthotics will re-align the feet to help the child walk more properly. Stretches or physical therapy may also be recommended.

If you have any concerns about your child and their feet, contact The Podiatrist.

Patients often have questions for The Podiatrist if they notice something unusual about their child’s feet or the way the child walks or runs. For many years, the most common pediatric foot problem seen in doctors’ offices has been in-toeing, especially whenever the child is observed while running.

Let’s briefly discuss several of the more common paediatric foot conditions that result in the feet turning inwards, as well as how these conditions can (and should) be managed by The Podiatrist.

A case relating to paediatric in-toeing often begins when the parent reports an abnormal appearance of the child’s foot, an awkward gait or a “clumsiness,” with a tendency to trip or fall. A structural and biomechanical examination of the lower extremities – including watching the child walk – will allow for differential diagnosis and appropriate treatment recommendations. In-toeing is generally caused by the following three conditions, whose corrective timing and treatment considerations vary.

Tibial Torsion

Tibial torsion is a common condition in which the tibia has not completed its external rotation to normal adult position (resulting, therefore, in a lack of normal torsion). The key to diagnosis is the closed-chain postural evaluation. On standing examination, the child’s knees face forward while the ankles and feet turn inward.

The natural history of tibial torsion is a gradual normalization with growth and use of the lower leg muscles. Most cases resolve by 2 years of age, but rotation values continue to increase an average of 1.5 degrees a year up to age 6. By age 7, the vast majority of children have achieved normal adult position.There is a familial tendency among those who fail to reach normal values. When tibial torsion persists, compensatory pronation commonly develops.

Suggested Care:

Parents need to be involved in the care of their children. Train parents to frequently stretch the medial soft tissues of their child’s lower leg. Show them how to strengthen the peroneal muscles (using a home exercise program and an extremity rehab system) when the child is old enough to cooperate sufficiently.

In addition, recommend buying shoes for the child that have flexible soles and good support to decrease pronation stresses. In cases of hyperpronation, individually designed paediatric orthotics should be considered. Finally, recommend beneficial activities and sports that emphasize lower-leg training and coordination (such as soccer)

Femoral Torsion

Femoral torsion is an inward (medial) rotation of the entire lower leg that begins at the neck of the femur. It is a relatively common childhood condition, one which can be recognized by the medial facing of the knee as well as the ankle and foot. With walking, more than 90 percent will resolve by the 8th year.

Any persistence is thought to be due to ligament laxity of the hip joint capsule. In such cases, physical examination will find excessive passive internal hip rotation. Lumbar hyperlordosis, genu recurvatum, and hyperpronation are frequently associated.

Suggested Care:

Begin strengthening the external rotator muscles and extensors of the hip by using an extremity rehab system. Parents can passively stretch the hips into external rotation, and the child should be encouraged to sit cross-legged.

Let parents know that shoes with good support are very important. When hyperpronation is noted, individually designed stabilizing orthotics are indicated to prevent further problems. Also, encourage physical activities such as ballet, skating and bike riding – all of which tend to engage the external rotator musculature of the hips.

Metatarsus Adductus

Metatarsus adductus (also known as a “hooked foot”) is a contracture of the medial soft tissues of the foot. This condition has been found to be present in 6 percent of schoolchildren. On examination, the in-toeing can be passively stretched to normal, since there is no bony abnormality associated.

More than 90 percent of infants with this condition will resolve by the age of 18 months. When more than mild adduction persists beyond 1 year of age, a consultation with The Podiatrist or orthopedic surgeon for consideration of casting is appropriate. However, casting and special foot braces are seldom necessary.

Suggested Care:

Instruct parents to massage and stretch the medial soft tissues of the infant’s foot for several minutes following each diaper change. Frequent stretching is the key. Consider an evaluation by a specialist if significant adduction persists beyond 1 year of age, or if the deformity feels fixed and cannot be temporarily reduced with gentle stretching. Orthotics are needed only if mild adduction continues beyond age 7.

Proper shoe sizing and fit are critical, since the developing bones are soft and malleable. Tight, constricting shoes will interfere with normal growth and may result in deformity. Frequent evaluation of shoe size and fit (palpate the child’s foot for pressure points while they are standing with shoes on) is an important concept for parents.

When to Recommend Orthotics

As described above, the majority of paediatric foot problems will resolve with normal childhood activities, exercise and proper footwear. Orthotics are seldom needed in the early years of growth. If excessive pronation associated with in-toeing is seen to persist beyond the age of 7 or 8, or is responding poorly to home care interventions, individually designed stabilizing orthotics are appropriate.

The additional corrective support they provide will encourage normal development while preventing further deformity and reducing abnormal kinetic-chain stresses on the pelvis and spine during formative years. Parents will need to be educated to bring their child in for regular evaluations of orthotic fit and function, since children’s feet can rapidly outgrow any orthotic.

Serving the Next Generation of Patients

Parents need reassurance and appropriate recommendations when they bring in a child with a “foot problem.” In particular, in-toeing can raise concerns in parents and may be frustrating to athletically oriented children. Most of the common causes of in-toeing in children will resolve during normal growth and development, needing only home-care recommendations and monitoring by the family’s chiropractor.

As always, the child’s developing spine should be evaluated and appropriate Podiatic care is recommended. Specific home exercises may hasten the maturation and coordination of the support muscles. In some cases, paediatric orthotics may be needed to provide additional corrective stimulus.

Should you have any questions or concerns, seek professional advice before starting any homecare.